As Suspected
Using the “Preliminary ACR” diagnostic criteria is taking us
down the wrong road. As I was perusing Pub Med, I found many papers, some pro
and some con, on this supposed unapproved diagnostic criteria developed by Dr.
Frederick Wolfe as principle investigator. (See the letter I received from the
American College of Rheumatology, here.)
Interestingly, those studying fibromyalgia in cancer
patients do not agree. This is a sampling that speaks to my concerns as drafted
in my last blog. Hey! American College of Rheumatology, What’s the Deal?
Dreher T, Häuser W, Schiltenwolf M.
[Fibromyalgiasyndrome - updated s3 guidelines]. Z Orthop Unfall. 2013 Dec;151(6):603-9. doi:
10.1055/s-0033-1350985. Epub 2013 Dec 17. [Article in German]
According to the modified ACR criteria, 2010, chronic
widespread pain and accompanying sleep disturbances and a physical as well as
mental state of exhaustion lead to the diagnosis of fibromyalgia syndrome. It
is not mandatory to check tender points (ACR 1990 criteria). A graduated
treatment approach depending on the severity level of the fibromyalgia syndrome
in the individual patient is recommended. Active treatment options (aerobic
training, meditative movement therapies, strength training) should be preferred
to any drug therapy in the long-term treatment of fibromyalgia. If indicated,
amitryptiline or duloxetine may be used to treat accompanying depressive or
generalised anxiety disorder. Muscle relaxant medication, non-steroidal
anti-inflammatory drugs and strong opioids should be avoided. The multimodal
pain therapy considering all psycho-social aspects is a promising treatment
option for fibromyalgia syndrome of moderate to high severity. {So it’s back to
all in our head. All these treatment modalities would be recommended to anyone
with chronic pain, they are not specific to FM. Interestingly, Hauser and Wolfe
have done studies together. And hey! these criteria have NOT BEEN APPROVED BY THE ACR. Cc]
Change Perspectives
You will find the following study very interesting from an entirely
different perspective.
Tanriverdi O.
Is a new perspectivefor definition and diagnostic criteria of fibromyalgia in early stage cancerpatients necessary? Med Hypotheses. 2014 Apr;82(4):433-6. doi:
10.1016/j.mehy.2014.01.018. Epub 2014 Jan 27.
Fibromyalgia is a most common pain syndrome
characterized by the presence of chronic widespread pain and tenderness with
manual palpation. However there is no enough data about frequent of fibromyalgia syndrome in patients with cancer. How
often FM is being used in oncological practice and how we are managing this
case by medical oncologists. Widespread pain index and symptom severity scale
are not clear enough in patients with cancer when ACR-2010 diagnostic criteria for FM are considered. In conclusion,
there is it may more prevalence of fibromyalgia in patients with cancer. For the diagnosis
of fibromyalgia, be new diagnostic criteria for early-stage cancer patients.
Criteria that Affects the Future of Fibromyalgia
As most of you
know, I support the Bennett, et al critieria for obvious reasons and they are
given in my my blog “The 2013 Alternative Criteria
Dr. Robert Bennett, et al. – Interpretation for patients and providers by Celeste
Cooper, here.
I would like to see how it performs in the real world. My suspicions are that
it will outperform, there will be fewer gray areas, and answer the questions
asked by Dr. Tanriverdi.
A Sampling - Collaboration between Dr. Wolfe and Dr. Häuser
Fibromyalgia prevalence, somatic symptom reporting,and the dimensionality of polysymptomatic distress:results from a survey of the general population.
See the interview on this paper here.
Fibromyalgia and physical trauma:the concepts we invent.
Abstract
CONCLUSIONS:
Despite weak to nonexistent evidence
regarding the causal association of trauma and fibromyalgia (FM), literature
and court testimony continue to point out the association as if it were a
strong and true association. The only data that appear unequivocally to support
the notion that trauma causes FM are case reports, cases series, and studies
that rely on patients' recall and attribution - very low-quality data that do
not constitute scientific evidence. Five research studies have contributed
evidence to the FM-trauma association. There is no scientific support for the
idea that trauma overall causes FM, and evidence in regard to an effect of
motor vehicle accidents on FM is weak or null. In some instances effect may be
seen to precede cause. Alternative causal models that propose that trauma
causes "stress" that leads to FM are unfalsifiable and unmeasurable.
Abstract
CONCLUSIONS:
All patients with fibromyalgia will satisfy the DSM-5 "A"
criterion for distressing somatic symptoms, and most would seem to satisfy
DSM-5 "B" criterion because symptom impact is life-disturbing or
associated with substantial impairment of function and quality of life. But the
"B" designation requires special knowledge that symptoms are
"disproportionate" or "excessive," something that is
uncertain and controversial. The reliability and validity of DSM-5 criteria in
this population is likely to be low.
~ • ~ • ~ • ~ • ~ • ~
Update 2015
"Adversity is only an obstacle if we fail to see
opportunity."
Celeste Cooper, RN
New Website
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All answers and blogs are based on the author's opinions and
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The suggestion of treating FM only with depression meds is NUTS! Those suggesting it are the ones needing their heads examined. As someone diagnosed in 1988, I know the prejudice patients have faced. I've fought the battle in my own way. The "all in our heads" suggestion will set us back at least 30 years if it is widely accepted. Keep up the fight Celeste! We just can't allow the uneducated, closed-minded to take us back to the "dark ages"!
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